Ranganathan Sanjana, Riveros Carlos, Tsugawa Yusuke, Geng Michael, Mundra Vatsala, Melchiode Zachary, Ravi Bheeshma, Coburn Natalie, Jerath Angela, Detsky Allan S, Wallis Christopher J D, Satkunasivam Raj
Department of Urology, Houston Methodist Hospital, Houston, Texas.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
JAMA Netw Open. 2025 Mar 3;8(3):e2458794. doi: 10.1001/jamanetworkopen.2024.58794.
The phenomenon of a weekend effect refers to a higher potential for adverse outcomes in patients receiving care over the weekend. Few prior studies have comprehensively investigated the effects of postoperative weekend care on surgical outcomes in a generalizable cohort.
To examine differences in short-term and long-term postoperative outcomes of patients undergoing surgical procedures immediately before vs after the weekend.
DESIGN, SETTING, AND PARTICIPANTS: This is a population-based, retrospective cohort secondary analysis of adult patients in Ontario, Canada, undergoing 1 of 25 common surgical procedures between January 1, 2007, to December 31, 2019, with 1 year of follow-up. Data analysis was performed from October to November 2022.
Undergoing surgery before (1 day before) vs after (1 day after) the weekend.
The primary outcome was a composite of death, readmission, and complications at 30 days, 90 days, and 1 year. Multivariable generalized estimating equations with an independent correlation structure, accounting for covariates, with clustering on surgical procedure were used to estimate the association between day of surgery in relation to the weekend and the outcomes.
Of the 429 691 patients (mean [SD] age, 58.6 [16.9] years; 270 002 female patients [62.8%]) in the study cohort, 199 744 (46.5%) underwent surgery before the weekend, and 229 947 (53.5%) underwent surgery after the weekend. Patients in the preweekend group were more likely than those in the postweekend group to experience the composite outcome of death, complications, and readmissions at 30 days (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08), 90 days (aOR, 1.06; 95% CI, 1.03-1.09), and 1 year (aOR, 1.05; 95% CI, 1.02-1.09) after surgery. Odds of mortality were increased in the preweekend group vs the postweekend group at 30 days (aOR, 1.09; 95% CI, 1.03-1.16), 90 days (aOR, 1.10; 95% CI, 1.03-1.17), and 1 year (aOR, 1.12; 95% CI, 1.08-1.17).
In this retrospective multi-institutional study, patients who underwent surgery immediately preceding the weekend had a significantly increased risk of complications, readmissions, and mortality compared with those treated after the weekend. Further study is needed to understand differences in care that may underpin these observations and ensure that patients receive high-quality care regardless of the day of the week.
周末效应现象是指在周末接受治疗的患者出现不良结局的可能性更高。此前很少有研究在可推广的队列中全面调查术后周末护理对外科手术结局的影响。
研究在周末之前与之后立即接受外科手术的患者在术后短期和长期结局上的差异。
设计、背景和参与者：这是一项基于人群的回顾性队列二次分析，研究对象为2007年1月1日至2019年12月31日期间在加拿大安大略省接受25种常见外科手术之一且有1年随访期的成年患者。数据分析于2022年10月至11月进行。
在周末之前（前1天）与之后（后1天）接受手术。
主要结局是术后30天、90天和1年时死亡、再入院和并发症的综合情况。使用具有独立相关结构、考虑协变量并按外科手术进行聚类的多变量广义估计方程来估计手术日相对于周末与结局之间的关联。
在研究队列的429691名患者（平均[标准差]年龄为58.6[16.9]岁；270002名女性患者[62.8%]）中，199744名（46.5%）在周末前接受手术，229947名（53.5%）在周末后接受手术。周末前组患者在术后30天（调整优势比[aOR]，1.05；95%置信区间[CI]，1.02 - 1.08）、90天（aOR，1.06；95%CI，1.03 - 1.09）和1年（aOR，1.05；95%CI，1.02 - 1.09）时出现死亡、并发症和再入院综合结局的可能性高于周末后组。周末前组与周末后组相比，30天（aOR，1.09；95%CI，1.03 - 1.16）、90天（aOR，1.10；95%CI，1.03 - 1.17）和1年（aOR，1.12；95%CI，1.08 - 1.17）时的死亡几率增加。
在这项回顾性多机构研究中，与在周末后接受治疗的患者相比，在周末前立即接受手术的患者出现并发症、再入院和死亡的风险显著增加。需要进一步研究以了解可能导致这些观察结果的护理差异，并确保患者无论在一周中的哪一天都能获得高质量的护理。
